Healthcare Provider Details

I. General information

NPI: 1972870194
Provider Name (Legal Business Name): LAURA J. RILEY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 7TH ST SW
CANTON OH
44710-1709
US

IV. Provider business mailing address

THE UNIV OF AKRON NSG CENTER MGH # 116 209 CARROLL STREET
AKRON OH
44325-3703
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-6242
  • Fax: 330-363-3877
Mailing address:
  • Phone: 330-972-6968
  • Fax: 330-972-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA-12683-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: